TY - JOUR
T1 - Impact of obstructive sleep apnea on cardiometabolic health in a random sample of older adults in rural South Africa
T2 - Building the case for the treatment of sleep disorders in underresourced settings
AU - Roche, Johanna
AU - Rae, Dale E.
AU - Redman, Kirsten N.
AU - Knutson, Kristen L.
AU - Von Schantz, Malcolm
AU - Gómez-Olivé, F. Xavier
AU - Scheuermaier, Karine
N1 - Funding Information:
All authors have seen and approved the manuscript. The study was supported by the Academy of Medical Sciences Newton Advance Fellowship to M.v.S. and F.X.G.-O., and by a postdoctoral fellowship from the University of the Witwatersrand’s University Research Council to J.R. The authors report no conflicts of interest.
Publisher Copyright:
© 2021 American Academy of Sleep Medicine.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Study Objectives: The association between obstructive sleep apnea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in southern Africa. We measured polysomnography-derived sleep characteristics, OSA prevalence, and its association with cardiometabolic diseases in a rural, low-income, African-ancestry sample of older adult participants in South Africa. Methods: Seventy-five participants completed the study. Body mass index, hypertension, diabetes, dyslipidemia, and HIV statuswere determined. AcontinuousCMRscore was calculated using waist circumference, random glucose, high-density-lipoprotein cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnea-hypopnea index for detection of the OSA (apnea-hypopnea index ≥ 15 events/h) were assessed by home-based polysomnography. Associations between CMR score and age, sex, socioeconomic status, apnea-hypopnea index, and total sleep time were investigated by multivariable analysis. Results: In our sample (53 women, age 66.1 ± 10.7 years, 12 HIV+), 60.7% of participants were overweight/obese, 61.3% were hypertensive, and 29.3% had undiagnosed OSA. Being older (P = .02) and having a higher body mass index (P = .02) and higher waist circumference (P < .01) were associated with OSA. Apnea-hypopnea index severity (β = 0.011; P = .01) and being a woman (β = 0.369; P = .01) were independently associated with a higher CMR score in socioeconomic status- and age-adjusted analyses. Conclusions: In this South African community with older adults with obesity and hypertension, OSA prevalence is alarming and associated with CMR.We show the feasibility of detecting OSA in a rural setting using polysomnography. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population to prevent future cardiovascular morbidity, especially among women.
AB - Study Objectives: The association between obstructive sleep apnea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in southern Africa. We measured polysomnography-derived sleep characteristics, OSA prevalence, and its association with cardiometabolic diseases in a rural, low-income, African-ancestry sample of older adult participants in South Africa. Methods: Seventy-five participants completed the study. Body mass index, hypertension, diabetes, dyslipidemia, and HIV statuswere determined. AcontinuousCMRscore was calculated using waist circumference, random glucose, high-density-lipoprotein cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnea-hypopnea index for detection of the OSA (apnea-hypopnea index ≥ 15 events/h) were assessed by home-based polysomnography. Associations between CMR score and age, sex, socioeconomic status, apnea-hypopnea index, and total sleep time were investigated by multivariable analysis. Results: In our sample (53 women, age 66.1 ± 10.7 years, 12 HIV+), 60.7% of participants were overweight/obese, 61.3% were hypertensive, and 29.3% had undiagnosed OSA. Being older (P = .02) and having a higher body mass index (P = .02) and higher waist circumference (P < .01) were associated with OSA. Apnea-hypopnea index severity (β = 0.011; P = .01) and being a woman (β = 0.369; P = .01) were independently associated with a higher CMR score in socioeconomic status- and age-adjusted analyses. Conclusions: In this South African community with older adults with obesity and hypertension, OSA prevalence is alarming and associated with CMR.We show the feasibility of detecting OSA in a rural setting using polysomnography. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population to prevent future cardiovascular morbidity, especially among women.
KW - Cardiometabolic risk
KW - Objective sleep
KW - Older
KW - Polysomnography
KW - Sleep-disordered breathing
KW - Sub-Saharan Africa
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U2 - 10.5664/jcsm.9214
DO - 10.5664/jcsm.9214
M3 - Article
C2 - 33687325
AN - SCOPUS:85112490458
VL - 17
SP - 1423
EP - 1434
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
SN - 1550-9389
IS - 7
ER -
